PubMed Health⌕ Search

Biomedical subjects

R T Lewis

Publications and source records attributed to R T Lewis.

At least 37 records · Page 2Linked to original sources
PubMed1984

Knitted polypropylene (Marlex) mesh in the repair of incisional hernias.

In 50 consecutive patients, large incisional hernias or those difficult to manage were repaired by suture imbrication of the hernial sac and extrafascial onlay fixation of Marlex mesh. Seromas developed in three and wound infection in two. The use of closed suction drains for all patients and antibiotic prophylaxis before and after operation for patients with antecedent wound infections may prevent these complications. In the follow-up period (mean of 2.6 years), lateral recurrence of the hernias occurred in three patients, but there has been no recurrence in the last 2 years. The method of repair is simple and effective.

Adult↗
PubMed1983

Are first-generation cephalosporins effective for antibiotic prophylaxis in elective surgery of the colon?

First-generation cephalosporins have recently declined in popularity as antibiotics for prophylaxis in elective surgery of the colon, but their efficacy has not been defined precisely. In a prospective randomized study, 44 patients who underwent elective colonic operations received, preoperatively, cefazolin in a parenteral dose adequate to kill aerobic coliforms. Six had wound infections; Bacteroides fragilis was grown, along with other organisms, from all these wounds. In contrast, only 1 of 57 similar patients had a wound infection after receiving, preoperatively, erythromycin base and metronidazole orally--directed at anaerobic bacteria. Local contamination, predominantly by anaerobic bacteria, is the main cause of wound infection after elective surgery of the colon. Even in what seems to be adequate dosage, first-generation cephalosporins are not antibiotics of first choice for preventing wound infections after these operations.

Aged↗
PubMed1982

Cefamandole in gastroduodenal surgery: a controlled, prospective, randomized, double-blind study.

Acceptance of the value of antibiotic prophylaxis in gastroduodenal surgery is growing, but only one controlled, double-blind study justifying this is available. In this second, controlled, randomized, double-blind study 60 patients underwent urgent and elective gastroduodenal operations. Among 32 patients receiving cefamandole perioperatively for prophylaxis, only 1 subsequently had a wound infection, but wound infections occurred in 8 of the 28 patients who received a placebo (P less than 0.01). Infection rates were higher in contaminated wounds and in urgent operations than in clean-contaminated wounds and elective surgery. The results confirm the value of antibiotic prophylaxis in this setting.

Cefamandole↗
PubMed1982

The conduct of cholecystectomy: incision, drainage, bacteriology and postoperative complications.

The benefits of some ancillary techniques of cholecystectomy are exaggerated by retrospective study of selected patients. Therefore, the authors performed a prospective, randomized study of 100 consecutive patients who underwent simple elective cholecystectomy for chronic cholecystitis and cholelithiasis. No patient was excluded because of incomplete hemostasis or fear of bile leakage. The frequency of pulmonary complications and wound infections was independent of the type of incision--vertical or subcostal. Peritoneal drainage was found to be unnecessary. Short-term drainage may increase the frequency of postoperative fever, but did not increase pulmonary complications or wound infections. In these patients, intra-abdominal sepsis is rare; wound infections were uncommon and the gallbladder bile was usually sterile and not the cause of postoperative infection.

Bile↗
PubMed1981

Preventing anaerobic infection in surgery of the colon.

A randomized prospective study of antibiotic prophylaxis was carried out in patients who underwent elective surgery of the colon. The wound infection rate in 70 patients who received cephradine intravenously in the perioperative period (group 1) was 25%, compared with 8% in 60 patients who received metronidazole and erythromycin base orally before operation (group 2). Both Bacteroides fragilis and Escherichia coli were cultured from the majority of wound infections in group 1, but B. fragilis was not found in any group 2 patients. Wound contamination indicated by wound class or by culture of the subcutaneous tissue of the wound before closure was the best predictor of subsequent wound infections. These results suggest a dominant role for intestinal anaerobes in the genesis of wound infections after colonic surgery and show that antibiotics specifically directed against these organisms can substantially reduce the rate of wound infection.

Administration, Oral↗
PubMed1981

Antibiotic prophylaxis in surgery.

This review examines the principles and practice of antibiotic prophylaxis in surgery. Such prophylaxis is required to decrease the frequency of postoperative infection in most patients with clean-contaminated and contaminated wounds, to prevent infrequent but devastating infection of prostheses in cardiovascular and orthopedic surgery and to prevent endocarditis in noncardiac surgery in patients who have valvular heart disease. Prophylaxis should begin before operation; it is usually unnecessary afterwards. The antibiotic may be given topically or parenterally. The latter is more certain, but oral prophylaxis in bowel surgery may offer additional protection by reducing colonic flora, and topical wound and peritoneal antibiotics may be augment protective antibiotic levels at those sites. Antibiotics, such as the cephalosporin cefazolin (but not cephalothin), which penetrate blood and tissues rapidly and for prolonged periods, afford excellent prophylaxis at most sites. But for prophylaxis in colonic surgery, antibiotics directed against Bacteroides fragilis may be superior, and to prevent endocarditis in noncardiac surgery, vancomycin or a combination of penicillin and an aminoglycoside is best.

Administration, Oral↗
PubMed1980

Albumin: role and discriminative use in surgery.

Exogenous human serum albumin (HSA) is generally used empirically and its role in surgery is poorly defined. The function and kinetics of HSA in the body are reviewed to provide rational guidelines for its use in surgery. Starling's law of transcapillary exchange is important, especially when applied to the capillary beds of the skin and subcutaneous tissue, skeletal muscle, lungs and intestines; but it overestimates the importance of maintaining oncotic pressure in the two situations where HSA is clinically beneficial--hypovolemia and plasma volume sequestration. In hypovolemia, the harmful effects of protein dilution by massive crystalloid resuscitation are minimized initially by "edema safety factors", such as reduced oncotic pressure of interstitial fluid and increased flow of lymph, and subsequently by intravascular protein refill from extravascular sites. But in severe hypovolemia, albumin should be given early, with sufficient isotonic saline, to reduce the total volume of crystalloid required. In the first 24 hours of plasma volume sequestration, albumin infused intravenously may be lost from excessively permeable capillaries; but later, hyperoncotic HSA is useful to restore the plasma volume and to reduce interstitial edema.

Blood Pressure↗
PubMed1979

Discriminate use of antibiotic prophylaxis in gastroduodenal surgery.

In a prospective study of 107 patients undergoing surgery for gastroduodenal disease, antibiotics were withheld from a group of 24 patients defined preoperatively to be at low risk of developing postoperative infections; no wound infection occurred in this group. Perioperative cephaloridine was randomized among the remaining patients (high risk). Wound infections developed in 11 of 42 patients who did not receive cephaloridine, but in none of the 41 patients who were given cephaloridine (p less than 0.02). Coliform bacteria were grown only from swabs of the stomach mucosa of patients in the high risk group and were the main cause of wound infections. Severe preoperative lymphocytopenia was frequently associated with the development of serious postoperative sepsis. The results validate a policy of restricting antibiotic prophylaxis in gastroduodenal operations to patients at high risk of postoperative infection and suggest a new risk factor--the preoperative blood lymphocyte count.

Adult↗
PubMed1979

Spontaneous aortoduodenal fistula: successful treatment by extra-anatomic vascular bypass.

A 77-year-old woman was admitted to hospital with massive upper gastrointestinal bleeding of obscure etiology and a palpable abdominal aortic aneurysm. A spontaneous aortoduodenal fistula, discovered at operation, was treated successfully by resection of the aneurysm, aortic closure, lateral duodenal repair and axillobilateral femoral grafting. The three clues to the correct diagnosis were: a palpable, pulsatile abdominal mass, recurrent abrupt cardiovascular collapse and significant upper gastrointestinal bleeding with no obvious source. The conventional method of treatment--aortic resection, duodenal repair, and intra-abdominal aortic grafting--is followed by secondary infection and aortic anastomotic bleeding, and by death in nearly 50% of the patients. The method of treatment used by the authors in this patient may be safer and deserves further consideration.

Aged↗
PubMed1979

Nontraumatic hemobilia: disparate episodes 7 years apart in the same patient.

A case is reported of nontraumatic hemobilia, which occurred twice in the same patient. Initially it was due to carcinoma of the gallbladder and 7 years later it was due to a ruptured intrahepatic aneurysm. The management of these two conditions is reviewed. The clinical marker of nontraumatic hemobilia originating in the gallbladder is the hemocholecyst and the treatment is cholecystectomy. Ruptured intrahepatic aneurysm can be diagnosed only by angiography. Cholangiography is indicated to rule out pathologic conditions of the ducts. In the absence of hepatobiliary sepsis selective hepatic artery ligation is the preferred treatment, otherwise hepatic resection is required.

Aged↗
PubMed1979

Severe coagulopathy following insertion of the LeVeen shunt: a potentially fatal complication.

Four patients who underwent insertion of the LeVeen shunt for treatment of medically intractable hepatic ascites had coagulation changes. Peritoneo-venous shunting was associated with a mild coagulopathy in two patients, simulating disseminated intravascular coagulation or primary fibrinolysis. The coagulopathy was severe in two patients and life-threatening in one of these. Postoperative coagulopathy may be detected by careful monitoring of coagulation indices and the risk of its development parallels the severity of liver disease.

Adult↗
PubMed1978

Antibiotics in surgery of the colon.

In a randomized prospective study of patients undergoing elective colonic surgery the postoperative wound infection rate was 13% (early, 10%) in patients receiving systemic cephaloridine perioperatively and 12% (early, 7.3%) in those given oral neomycin and erythromycin base preoperatively. Wound infections were more frequent in patients with severe lymphopenia or hypoalbuminemia preoperatively, but the potential degree of wound contamination was the main determinant of postoperative infection.

Aged↗
PubMed1977

Wound infection after gastroduodenal operations: a 10-year review.

A review of 444 gastric operations performed over a 10-year period revealed striking differences in wound infection rates when the operations were categorized according to the major indication for surgery. On this basis, low-intermediate- and high-risk groups were recognized. A subsequent prospective randomized study confirmed the predictive value of this categorization and showed that the administration perioperatively of prophylactic systemic antibiotics in high-risk patients will protect them from postoperative wound infection.

Adolescent↗